Injured workers with an accepted WorkCover claim are entitled to have their “reasonable medical and like expenses” paid for by the insurer. But what medical expenses are covered, and what does ‘and like’ mean?
Commonly claimed medical expenses include attendances at your doctor, physiotherapy, surgery, hydrotherapy and gym programs. You may also claim attendances with a psychologist or a psychiatrist, along with medication. The medical treatment must be reasonable, and related to your work injury. In most cases a doctor needs to recommend the treatment and make the request for funding.
‘And like’ services refer to assistance you may need while recovering from your injury, such as house cleaning and travel costs to medical appointments (public transport or mileage).
Do I have to pay medical expenses while on WorkCover?
Most doctors, therapists and pharmacists should be able to bill the WorkCover insurer directly. If they cannot, then you must get a receipt for the treatment, and send it in to your insurer to claim within six months of treatment. Importantly, keep a copy of the receipt.
Why aren’t WorkCover paying the full amount?
Payment of the reasonable costs of services does not necessarily mean payment of the full costs. As with Medicare, in some cases there may be a gap between what the provider charges and what the insurer, WorkCover, will pay.
What if WorkCover stops paying?
This often happens after 130 weeks, and occurs because the insurance company has disputed your capacity for work.
You do not have to accept their decision, and we encourage you to get legal advice if you require payments to be reinstated.
If WorkCover refuses to pay for something you or your doctor have requested, or tell you they are not going to pay for any more of a particular type of treatment, you can fight this decision.
If the WorkCover insurer makes a decision that you disagree with, you can challenge it by referring the decision/dispute to the Accident Compensation Conciliation Service (ACCS) for a conciliation conference. Disputes must be referred to Conciliation within 60 days of receiving the WorkCover insurer’s decision notice.
The ACCS is an independent body established to help resolve disputes between employers, WorkCover insurers and workers. In order to refer a dispute for Conciliation, a Request for Conciliation form needs to be filled out and sent to the ACCS together with a copy of the notice you are disputing. Your lawyer can assist with this.
Once a referral is made to the ACCS a conciliation conference is convened which you will be required to attend along with the WorkCover insurer.
If you disagree with a decision that the WorkCover insurer has made, feel free to contact one of our lawyers for advice on (03) 9321 9988.